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January 19, 2011

Before and After Obamacare Repeal

By

Americans want health care reform, but not the 2,000-plus page monstrosity known as Obamacare.

Just two days before Wednesday's House vote to repeal the law, a CNN poll found that half of all Americans wanted to scuttle Obamacare in toto, while only 6 percent wanted to retain it intact.

Why not just fix the bad parts and keep the good ones? Because you can't build sound market-based health reform on the sands of Obamacare. Beyond its unprecedented mandates, new taxes, massive entitlement expansion, unworkable and costly insurance provisions, and its failure to control costs, the new law concentrates enormous power in the U.S. Department of Health and Human Services (HHS). Obamacare creates a giant network enabling HHS to micromanage health plan benefits, insurance markets, medical pricing and delivery of care. In sum, this "reform" cannot be saved, not even with radical legislative surgery.

Given the political realities in Washington, however, full repeal won't happen overnight. And until that moment comes, there's plenty Congress can do to keep Obamacare from making matters worse.

First of all, it can do much to block implementation of the law. The most straightforward way to do this is to deny funding for key provisions. For example, lawmakers could bar the Internal Revenue Service from using any funds to enforce the mandate requiring individuals to buy health insurance.

Lawmakers could also exercise their powers under the Congressional Review Act, which lets Congress halt onerous rules and regulations before they do damage to businesses or other sectors of the health care economy.

And Congress should exercise its oversight authority, conducting fair, open and thorough hearings on how the law is being implemented. Last year's rush to passage left many questions unanswered — and left many key implementation decisions in the hands of HHS. These decisions — for example, the administration's use of waivers and exemptions from its own rules — deserve scrutiny. So does the impact of the law on state budgets, the work force and the overall economy.

Once Obamacare is repealed, Congress can focus on doing health reform right, but giving people more viable health coverage choices and empowering them to select the option that suits their needs the best. A partial list of these "consumer-first" reforms would include:

• Providing individual tax relief for everyone purchasing private health insurance, regardless of where they work;

Letting individuals purchase health care coverage across state lines;

• Letting employers convert from defined-benefit health plans to defined contribution plans;

• Promoting new group purchasing arrangements based on individual membership organizations and various associations, unions, fraternal organizations and ethnic or religious associations;

• Improving access to coverage options such as health savings accounts or and flexible spending accounts that encourage greater transparency and consumer control over health expenditures;

• Extending rational pre-existing condition protections to those who clearly have not been trying to "game" the system;

• Using a competitive-bidding process to determine government payment in traditional Medicare fee-for-service and Medicare Advantage programs;

• Eliminating Medicare regulations that unduly burden doctors and patients (such as the restriction preventing patients from going outside the Medicare program to get medical services);

• Encouraging states to set up high-risk pools or other mechanisms to help cover hard-to-insure individuals;

• Strengthening premium assistance in Medicaid to help young families buy private health insurance coverage;

• Reducing Medicaid fraud and abuse (e.g., by tightening eligibility loopholes for long-term-care services).

How will Congress know it has achieved lasting effective health care reform? By making sure it promotes personal control through tax equity, ensures portability of health insurance; fixes financially troubled and underperforming government health care programs; and creates a federal-state partnership that gives each state sufficient leeway to address the particular challenges its health system must overcome.

These elements are at the core of transforming today's health care economy into one where individuals and families can control their own dollars and make their own decisions.

Nina Owcharenko is director of the Center for Health Policy Studies at the Heritage Foundation.

First appeared in The Washington Times

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